A California-based skilled nursing operator, along with 27 affiliated facilities, have agreed to pay $16.7 million in a settlement related to therapy upcoding allegations.
The Department of Justice disclosed the False Claims Act settlement with Longwood Management Corporation and its facilities in July. Three whistleblowers who had filed the two original lawsuits will receive about $3 million.
“When skilled nursing facilities provide rehabilitation therapy services based on maximizing revenue rather than the interests of their patients, we will hold them accountable,” said Acting Assistant Attorney General Ethan P. Davis for the DOJ’s Civil Division.
Federal authorities claimed that Longwood knowingly submitted false and fraudulent claims for “unreasonable and unnecessary” Ultra High levels of rehabilitation therapy to Medicare Part A residents. Medicare reimburses SNFs at a daily rate that reflects the skilled therapy and nursing needs of qualifying patients. The highest level of Medicare reimbursement SNFs is for “Ultra High” therapy patients. These patients require a minimum of 720 minutes of skilled therapy from two therapy disciplines.
The operator is alleged to have pressured therapists to increase the amount of therapy provided to meet preplanned targets for Medicare revenue. It allegedly set the targets without regard to patients’ individual therapy needs, and the targets could only be achieved by billing for a high percentage of patients at the Ultra High level, the DOJ said.
The alleged scheme happened at 21 facilities between January 2006 and October 2014, and at six other facilities between May 2008 and August 2012.
From the September 2020 Issue of McKnight's Long-Term Care News
